Implantation of a Small Aperture Intraocular Lens in Eyes with Irregular Corneas and Higher Order Aberrations
Purpose: Corneal irregularities can lead to high order aberrations (HOAs) and may influence the outcomes in terms of intraocular lens (IOL) selection and visual acuity assessment. The aim of this study was to evaluate the visual acuity and satisfaction after IC-8 implants in patients characterized by corneal irregularities and HOAs who could not undergo refractive surgery due to the poor residual thickness of the cornea or other conditions such as astigmatism secondary to previous radial keratotomy.
Methods: This descriptive, retrospective cohort study was conducted on nine eyes in six patients affected by corneal irregularities and HOAs who had undergone IC-8 IOL implantation. The primary endpoint was the best-corrected visual acuity (BCVA), the subjective visual function, and the visual field.
Results: Nine eyes of six patients (three bilateral implantation) were enrolled. For each patient, BCVA, vision, and lifestyle quality were evaluated. In all patients, we noticed an improvement in all parameters without visual field defects.
Conclusion: Our work encourages the use of the IC8 lens to improve visual acuity in patients with irregular corneas and HOAs who cannot be treated with customized refractive surgery. Patients experience a subjective improvement of their quality of vision and also more self-confidence in their daily life. IC-8 lenses do not interfere with the visualization of retinal fundus and there is no impairment of the visual field detected by patients.
Aberrations, Cataract, IC-8, Pinhole
1. Hawker MJ, Madge SN, Baddeley PA, Perry SR. Refractive expectations of patients having cataract surgery. J Cataract Refract Surg 2005;31:1970–1975.
2. Barrett GD. An improved theoretical formula for intraocular lens power prediction. J Cataract Refract Surg 1993;19:713–720.
3. Shajari M, Mackert M, Langer J, Kreutzer T, Wolf A, Kohnen T, et al. Safety and efficacy of a small-aperture capsular bag-fixated intraocular lens in eyes with severe corneal irregularities J Cataract Refract Surg 2020;46:188–192.
4. Braga-Mele R, Chang D, Dewey S, Foster G, Henderson BA, Hill W, et al. Multifocal intraocular lenses: Relative indications and contraindications for implantation. J Cataract Refract Surg 2014;40:313–322.
5. Grabner G, Ang RE, Vilupuru S. The small aperture IC-8 intraocular lens: A new concept for added depth of focus in cataract patient. Am J Ophthalmology 2015;160:1176–1184.e1.
6. Tucker J, Charman WN. The depth-of-focus of the human eye for Snellen letters. Am J Optom Physiol Opt 1975;52:3–21.
7. Ang RE. Visual performance of a small-aperture intraocular lens: First comparison of results after contralateral and bilateral implantation. J Refract Surg 2020;36:12–19.
8. Ogle KN, Schwartz JT. Depth of focus of the human eye. J Opt Soc Am 1959;49:273–280.
9. Yuan Y, Shao Y, Tao A, Shen M, Wang J, Shi G, et al. Ocular anterior segment biometry and high-order wavefront aberrations during accommodation. Invest Ophthalmol Vis Sci 2013;54:7028–7037.
10. Munoz G, Rohrweck S, Sakla HF, Altroudi W. Pinhole irisfixated intraocular lens for dysphotopsia and photophobia. J Cataract Refract Surg 2015;41:487–491.
11. Trinidade BLC, Trindade FC, Trindade CLC, Santhiago MR. Phacoemulsification with intraocular pinhole implantation associated with Descemet membrane endothelial keratoplasty to treat failed full-thickness graft with dense cataract. J Cataract Refract Surg 2018;44:1280–1283.
12. Trinidade CC, Trindade BC, Trindade FC, Werner L, Osher R, Santhiago MR. New pinhole sulcus implant for the correction of irregular corneal astigmatism. J Cataract Refract Surg 2017;43:1297–1306.
13. Tsaousis KT, Werner L, Trindade CLC, Guan J, Li J, Reiter N. Assessment of a novel pinhole supplementary implant for sulcus fixation in pseudophakic cadaver eyes. Eye 2018;32:637–645.
14. Grabner G, Ang RE, Vilupuru S. The small aperture IC-8 intraocular lens: A new concept for added depth of focus in cataract patient. Am J Ophthalmology 2015;160:1176–1184.e1.
15. Schultz T, Dick HB. Small-aperture intraocular lens implantation in a patient with an irregular cornea. J Refract Surg 2016;32:706–708.
16. Agarwal Franzco S, Thornell E. Cataract surgery with a small-aperture intraocular lens after previous corneal refractive surgery: Visual outcomes and spectacle independence. J Cataract Refract Surg 2018;44:1150– 1154.
17. Srinivasan S, Khoo LW, Koshy Z. Posterior segment visualization in eyes with small aperture intraocular lens. J Refract Surg 2019;35:538–542.
18. Holladay JT, Van Dijk H, Lang A, Portney V, Willis TR, Sun R, et al. Optical performance of multifocal intraocular lenses. J Cataract Refract Surg 1990;16:413–422.
19. Ang RE. Visual performance of a small-aperture intraocular lens: First comparison of results after contralateral and bilateral implantation. J Refract Surg 2020;36:12–19.
20. Shajai M, Mackert M, Langer J, Kreutzer T, Wolf A, Kohnen T, et al. Safety and efficacy of a small-aperture capsular bag-fixated intraocular lens in eyes with severe corneal irregularities. J Cataract Refract Surg 2020;46:188–192.
21. Hooshmand J, Allen P, Huynh T, Chan C, Singh R, Moshegov C, et al. Small aperture IC-8 intraocular lens in cataract patients: Achieving extended depth of focus through small aperture optics [EPub Ahead of Print]. Eye; 2019.